Department of Neurosciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA.
Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA.
Exp Neurol. 2024 Jun;376:114751. doi: 10.1016/j.expneurol.2024.114751. Epub 2024 Mar 12.
Despite great advances in acute care and rehabilitation, stroke remains the leading cause of motor impairment in the industrialized world. We have developed a deep brain stimulation (DBS)-based approach for post-stroke rehabilitation that has shown reproducible effects in rodent models and has been recently translated to humans. Mechanisms underlying the rehabilitative effects of this novel therapy have been largely focused on the ipsilesional cortex, including cortical reorganization, synaptogenesis, neurogenesis and greater expression of markers of long-term potentiation. The role of subcortical structures on its therapeutic benefits, particularly the striatum, remain unclear. In this study, we compared the motor rehabilitative effects of deep cerebellar stimulation in two rodent models of cerebral ischemia: a) cortical ischemia; and b) combined striatal and cortical ischemia. All animals underwent the same procedures, including implantation of the electrodes and tethered connections for stimulation. Both experimental groups received four weeks of continuous lateral cerebellar nucleus (LCN) DBS and each was paired with a no stimulation, sham, group. Fine motor function was indexed using the pasta matrix task. Brain tissue was harvested for histology and immunohistochemical analyses. In the cortical-only ischemia, the average pasta matrix performance of both sham and stimulated groups reduced from 19 to 24 pieces to 7-8 pieces following the stroke induction. At the end of the four-week treatment, the performance of stimulated group was significantly greater than that of sham group (14 pieces vs 7 pieces, p < 0.0001). Similarly, in the combined cortical and striatal ischemia, the performance of both sham and stimulated groups reduced from 29 to 30 pieces to 7-11 pieces following the stroke induction. However, at the end of the four-week treatment, the performance of stimulated group was not significantly greater than that of sham group (15 pieces vs 11 pieces, p = 0.452). In the post-mortem analysis, the number of cells expressing CaMKIIα at the perilesional cortical and striatum of the LCN DBS treated animals receiving cortical-only stroke elevated but not those receiving cortical+striatal stroke. The current findings suggested that the observed, LCN DBS-enhanced motor recovery and perilesional plasticity may involve striatal mechanisms.
尽管急性治疗和康复方面取得了巨大进展,但中风仍然是工业化世界导致运动障碍的主要原因。我们已经开发出一种基于深部脑刺激(DBS)的中风后康复方法,该方法在啮齿动物模型中显示出可重复的效果,并已最近转化为人类。这种新型治疗方法的康复作用的机制主要集中在病灶对侧皮质,包括皮质重组、突触形成、神经发生和长时程增强标记物的更大表达。皮质下结构在其治疗益处中的作用,特别是纹状体,仍然不清楚。在这项研究中,我们比较了深部小脑刺激在两种大脑缺血啮齿动物模型中的运动康复效果:a)皮质缺血;和 b)联合纹状体和皮质缺血。所有动物都接受了相同的程序,包括植入电极和用于刺激的系绳连接。两个实验组都接受了四周的连续外侧小脑核(LCN)DBS 治疗,每个实验组都与一个无刺激、假手术组配对。精细运动功能使用 pasta 矩阵任务进行评估。收获脑组织进行组织学和免疫组织化学分析。在皮质缺血中,无论是假手术组还是刺激组,pasta 矩阵的平均表现都从中风诱导前的 19 块降至 24 块,再降至 7-8 块。在四周治疗结束时,刺激组的表现明显优于假手术组(14 块与 7 块,p<0.0001)。同样,在联合皮质和纹状体缺血中,无论是假手术组还是刺激组,pasta 矩阵的平均表现都从中风诱导前的 29 块降至 30 块,再降至 7-11 块。然而,在四周治疗结束时,刺激组的表现并不明显优于假手术组(15 块与 11 块,p=0.452)。在死后分析中,接受皮质性中风的 LCN DBS 治疗动物的病灶周围皮质和 LCN 刺激的纹状体中表达 CaMKIIα 的细胞数量增加,但接受皮质+纹状体中风的动物则没有。目前的发现表明,观察到的 LCN DBS 增强运动恢复和病灶周围可塑性可能涉及纹状体机制。